AYI at Energies Balanced 500 Hour Teacher Training Application

APPLICATION INSTRUCTIONS:

Be sure to complete the following documents when submitting your application:

500-hour Teacher Training Program Application Requirements:

Primary Electronic Application

Down Payment or Full tuition payment. If you are making a down payment to register, we request that you place your credit card on file with Energies Balanced to be charged depending on which tuition payment option you choose . We will collect your credit card information upon the first module weekend.

Program General Release Agreement that you can sign during our first meet up.

To reserve your place in the training, you must submit the completed application along with a down payment or a full tuition payment.

2018 EB Yoga Teacher Training Course Tuition

2018 EB Yoga Teacher Training Course Tuition

If including a check, please make payable to Energies Balanced. There are no refunds on down payments, full tuition payments or single module payments.

500 Hr Teacher Training Application

Yoga Teacher Training Application

Name *

Name

First Name

Last Name

Email Address *

Phone

Phone

(###)

###

####

Address *

City, State, Zip Code *

Emergency Contact Information

Please give the name, relation and phone number of your emergency contact person.

Start date of training your are applying for:

How did you learn about our program?

Medical History

Please complete the medical history section below so that we can ensure to respond to any emergencies
should they arise during your training. Please include a second sheet if necessary. Based on your specific
history, we may schedule a follow-up interview before accepting you in the program.

How would you evaluate your current health?

Please let us know if you have any injuries that may affect your ability to fully participate in the training.

Please list any medical conditions that may affect your ability to fully participate in the training.

Have you had any surgeries in the last year? If the answer is yes, please explain.

Is there anything else we should know about your medical history?

Safety is very important to us at Energies Balanced. At any time, your instructor may ask you to leave if you are not at the physical and/or health level to fully and safely participate, or if you are affecting the safety and learning of others.

About You

To better serve you, it is important that we have a general picture of your yoga practice and history. Please be as honest and clear as possible.

How long have you been practicing yoga?

How many days per week do you practice yoga?

What style of yoga do you usually practice?

At which yoga studios do you currently practice?

What area of yoga challenges you the most? (Please specify)

Is this your first training? (If no please list prior trainings.)

Are you currently teaching yoga? (If yes, please list where you are teaching.)

In your opinion, what makes a good yoga teacher and why?

What are your expectations for this training? What do you hope to achieve at the completion of the program? *

Which tuition payment option would you like to set up? *

Option 1: After $1000.00 program registration down payment, 16 payments total of: $175.00 per month.
Option 2: After $1000.00 program registration down payment, you can pay half the remaining balance ($1400.00) upon program start date and the other remaining balance (1400.00) due 8 months after program start date.
Option 3: After $1000.00 program registration down payment, you make 4 installments ($700.00) towards the remainder of the tuition until your program date is finished. Payments would be made every 4 months from program start date for a total of 4 tuition payments.

Energies Balanced General Release

I understand that the practice of yoga involves physical movement and exercise which may be strenuous. I also understand that by practicing yoga, I risk physical injury. I, not Energies Balanced, am responsible for judging my physical capabilities while participating in yoga, fitness or exercise classes or performing physical activities of any kind in any location used by Energies Balanced (the “Studio”) or in any other setting in which Energies Balanced is involved, including but not limited to any and all workshops, yoga exhibitions, flash mobs and retreats (collectively, “Activity” or “Activities”) and I assume any and all of the risks associated with participating in such Activities. I understand that in the course of Activities, Energies Balanced instructors may suggest that I engage in certain poses, or use certain equipment such as blankets, blocks, belts, bolsters and yoga walls, while practicing yoga. It is my responsibility to judge whether I can safely perform Activities and use equipment. I will inform the instructor or Energies Balanced if I am not sure if I can perform an Activity or use equipment. It is my sole and absolute responsibility to ensure that I do not exceed my mental or physical limits, and that I do not engage in Activities harmful to my health. Energies Balanced has no responsibility to, and will not, provide me with medical advice. It is my sole and absolute responsibility to select the level of Activities and equipment suitable to my ability. I will inform the instructor or Energies Balanced immediately if I suffer any injury during any Activity or if I have any medical conditions that may affect my performance of any Activity. I understand that, from time to time during the Activities, instructors may physically adjust my body or guide me in the performance of exercise. If I do
not want such guidance or adjustments, I will inform the instructor in advance. In addition, I will tell the instructor when guidance or adjustment has gone as far as I desire. I waive and release any and all claims or liability that I may have at any time for injury of any sort, including but not limited to injury or disability through participation in the Activities and the use of equipment, against Energies Balanced and any person or entity involved with Energies Balanced, including without limitation its principals, directors, subsidiaries, affiliates, independent contractors, instructors, employees, agents, representatives, licensees, successors, and assigns. I understand that Energies Balanced is not responsible for my personal property or any lost or stolen items at the location. I expressly agree to hold harmless Energies Balanced or any person or entity in any way involved with Energies Balanced, including without limitation its principals, directors, subsidiaries, affiliates, independent contractors, instructors, employees, agents, representatives, licensees, successors, and assigns, for any loss resulting from lost or stolen property. Energies Balanced will not ask, require, or permit me to perform work on behalf of Energies Balanced. From time to time, instructors may use Activity participants for demonstrations. If I participate in demonstrations, I do so voluntarily. If I do not wish to participate in a demonstration, I will inform the instructor or Energies Balanced. I understand and agree that I may appear in Energies Balanced videos, online class footage, photographs or any other media or recordings which may be used for advertising, publicity, public displays and exhibitions and that my participation and inclusion may be edited by Energies Balanced in its sole and absolute discretion. I expressly waive and release any and all claims or liability I may have at any time with regard to my name, appearance, likeness, voice and image that is included in any and all Energies Balanced videos, website, footage, photographs, promotional materials, and ancillary products (“Materials”). For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, including, without limitation valuable instructional consideration, I hereby grant Energies Balanced the royalty-free and unrestrained, perpetual right to own, utilize and alter my name, appearance, likeness, voice and image in Energies Balanced videos, online class footage, photographs or any other media or recordings throughout the universe. I acknowledge, agree and stipulate that any and all
Material(s) is the property of Energies Balanced, owned exclusively by Energies Balanced, to do with it as it will in its sole and absolute discretion. I expressly release Energies Balanced, including without limitation its principals, directors, subsidiaries, affiliates, independent contractors, instructors, employees, agents, representatives, licensees, successors, and assigns, from and against any and all claims in law and equity which I have or may have for invasion of privacy, defamation, libel, slander, copyright or trademark violation, right of publicity or false light or any other cause of action arising out of the production, distribution, broadcast, exhibition, or use of the Materials in any and all media or recordings throughout the universe. This General Release is governed by the laws of the State of Texas. I CERTIFY THAT I HAVE CAREFULLY READ AND FULLY UNDERSTAND AND AGREE TO THE ABOVE. I AM AWARE THAT THIS IS A RELEASE OF CLAIMS AND LIABILITY AND A CONTRACT, AND I SIGN IT OF MY OWN FREE WILL. I HEREBY DECLARE THAT I AM AT LEAST 18 YEARS OLD.

Signature of Agreement *

If you consent to the Energies Balanced General Release, please print your correct legal name and print the word agrees next to your name. Notice: You can not proceed with our program if you do not give your full consent on the General Release Form. (You will also have to sign a physical copy of the form upon your next visit to Energies Balanced Yoga Studio.)